A multicenter randomized controlled trial comparing effectiveness of two nasal continuous positive airway pressure devices in very-low-birth-weight infants.

OBJECTIVE: Many studies suggest nasal continuous positive airway pressure is an effective and relatively complication-free means of respiratory support in premature infants. However, only limited data exist regarding the practical aspects of nasal continuous positive airway pressure delivery, including the best way to provide the positive airway pressure. DESIGN: Our aim was to compare the results of treatment using two different nasal continuous positive airway pressure devices: variable flow Infant Flow and constant flow nasal continuous positive airway pressure in two different groups of very-low-birth-weight infants in a multicenter randomized controlled trial. The indication groups were elective to avoid intubation and weaning from mechanical ventilation. SETTING: Twelve leading tertiary care neonatal centers in Poland. PATIENTS: Among 276 infants (weighing between 750-1500g, with a gestational age ≤32 wks) enrolled, 51% were randomized to receive Infant Flow and 49% to receive constant flow nasal continuous positive airway pressure. MEASUREMENTS AND MAIN RESULTS: Treatment success (i.e., no need for intubation/reintubation) occurred in 75% of our patients with a nonstatistically significant advantage seen with Infant Flow. The incidence of severe nasal complications and necrotizing enterocolitis were statistically significantly lower in the infants treated with Infant Flow. In our study, factors associated with elective nasal continuous positive airway pressure failure were birth weight ≤1000 g, gestational age ≤28 wks, clinical risk index for babies score >1, and PaO(2)/FIO(2) ratio of <150. Only birth weight ≤1000 g was associated with weaning failure. CONCLUSIONS: We found fewer severe nasal complications but no statistically significant advantage in treatment success in infants assigned to Infant Flow nasal continuous positive airway pressure compared with those assigned to constant flow nasal continuous positive airway pressure treatment. Significant risk factors of treatment failure include small size, maturity, and severity of respiratory distress syndrome.

[Thermal comfort in preterm babies. Infra-red colour thermography findings. Preliminary report]. / Ocena komfortu cieplnego u noworodków urodzonych przedwczesnie przy uzyciu metody termografii w podczerwieni - doniesienie wstepne.

OBJECTIVE: To assess the thermal comfort of clinically stable neonates with normal body temperature by using infra-red colour thermography (THY). MATERIAL AND METHODS: 32 babies were enrolled in the study. The axillary temperature was maintained in the range 36.6-37.0 degrees C and the air temperature in the incubator remained within the neutral range according to Hey and Katz. Temperature distribution was measured by THY The abdomen and foot skin temperature, as well as the difference between both parameters were recorded. Thermal comfort for THY was defined as a difference between core and peripheral temperatures (Deltat) in the range of 1 to 2 degrees C. RESULTS: Thermal comfort defined according to THY criterion was fulfilled only in 12 patients (37.5%). We found Deltat< 1 degree C in 14 patients (43.8%), and Deltat>2 degrees C in 6 patients (6.3%). Thermal comfort defined by standard care varied from founded by THY p<0.0001. High foot temperature >or=35.0 degrees C in THY was found as a determinant for Deltat< 10 degrees C. Multivariate logistic regression analysis found gestational age <30 weeks to be connected with the risk of hyperthermia [odds ratio 8.4 (95% Cl 1.2-61.2). CONCLUSIONS: We concluded that there is a risk for hyperthermia in prenaturely, immature babies when nursed in standard neutral temperature. Infra-red colour thermography gives additional information which can be used for further studies on determination of optimal thermal comfort in newborn.

[Evaluation of sick neonates' medical interventions in maternity units before transport to reference centres]. / Ocena jakosci przygotowania chorego noworodka w macierzystym oddziale noworodkowym do transportu miedzyszpitalnego.

BACKGROUND: Interhospital transfer of the sick neonate should be an integral part of neonatal intensive care. However, it is essential that the referring hospital is able to provide the appropriate standard of care from birth up to the point of transfer. OBJECTIVE: To evaluate the quality of medical interventions before interhospital transport of sick neonates. MATERIAL AND METHODS: Retrospective study based on review of all transport records of530 neonates who were transported at the Neonatal Intensive Care Unit (NICU) in 2006. The examined variables included medical interventions in the maternity unit and transport team interventions before and during the transport. RESULTS: During the study period there was as a total of 530 transfers to Neonatology Departments, 325 of them (61.32%) were transferred to the NICU and 205 (38.68%) to the Special Care Unit. Within the group of neonates transported to the NICU, 51 (15.7%) infants had hypothermia, 65 (20%) had no venous access before the transport. The most common form of respiratory therapy was oxygen therapy (89 (27.4%) neonates), followed by mechanical ventilation (65 (20%) and NCPAP ventilation (50 (15.4%) infants). As a result of transport team interventions the number of children with hypothermia decreased to 27 (8.3%). Peripheral intravenous devices were inserted in 52 (16%) neonates. The number of infants transported on mechanical ventilation increased to 115 (35.4%), 56 (17.2%) babies received NCPAP and 53 (16.3%) were on supplemental oxygen. The highest number of transport team interventions was found in the group of extremely low birth weight infants. CONCLUSIONS: Inadequate medical preparation of sick neonates in maternity hospital for interhospital transport was the reason for the high incidence of transport team interventions before moving the neonate to the NICU.

[Recommended treatment of apnea in premature infants. A review based on literature and own experience]. / Leczenie bezdechów u noworodków przedwczesnie urodzonych - zalecenia opracowane na podstawie danych z pismiennictwa i doswiadczen wlasnych.

The authors reviewed the literature concerning different methods of treatment of apnea in premature infants. The authors consider that, apart from pharmacological treatment, noninvasive respiratory support methods play an important role in the prevention and treatment of newborns with apnea. The aim of the study is to present current recommendations concerning the principles of prevention and treatment of apnea in premature infants. The compiled recommendations are based on the data from literature and from the authors' own experiences.

[Delivery room resuscitation with room air and oxygen in newborns. State of art, recommendations]. / Zastosowanie tlenu i powietrza w resuscytacji noworodka po urodzeniu, aktualne poglady, zalecenia.

The authors present and discuss the current data, concerning delivery room resuscitation with oxygen and room air in neonates. On the ground of the results obtained from literature and the Polish National Survey on Paediatric and Neonatal Intensive Care, 2007/2008 issue, the authors give the following proposals regarding optimal oxygen treatment: 1. there is a need for optimizing tissue oxygenation in order to prevent injury caused by radical oxygen species; 2. newborn resuscitation should be monitored by measuring the haemoglobin saturation - the values above 90%, found in resuscitated newborn within the first minutes of life may be dangerous and cause tissue injury; 3. starting the resuscitation with oxygen concentration lower than 40% and adjusting it according to the effects of the procedure - the less mature infant the lower oxygen concentration at the beginning of resuscitation; 4. heart rate >100/min and SatO2Hb between 70-80% within the first minutes of life should not be an indication for increasing oxygen concentration.

[Weaning newborns from noninvasive ventilation]. / Zasady uwalniania noworodków z wentylacji neinwazyjnej.

The purpose of the study was to propose the recommendations for weaning infants from nasal continuous positive airway pressure (nCPAP) and nasal intermittent positive pressure ventilation (NIPPV). Despite the fact that both methods are commonly used for respiratory insufficiency in infants, detailed recommendations for weaning have not been described so far. The proposed recommendations are based on previously described data and a wide survey conducted among Polish neonatologists and intensive therapy paediatricians.

[Local complications during nasal continuous positive airway pressure method therapy]. / Powiklania miejscowe podczas terapii metoda nosowego ciaglego dodatniego cisnienia w drogach oddechowych.

A review of the current knowledge about local complications during nasal continuous positive airway pressure method therapy in the neonate with respiratory failure is the subject of this article. In the authors' conviction, local damages make up one of the main causes of failure of therapy, or its interruption, especially in the newborn with extremely low birth weight. Apart from review of the literature, the authors describe the causes of the most frequent damages as well as methods of their prevention and treatment, developed during many years of using of this form of ventilation.

Introduction of Infant Flow nasal continuous airway pressure as the standard of practice in Poland: the initial 2-year experience.

OBJECTIVE: The aim of this prospective study was to evaluate whether a change in the standard of newborn care for respiratory insufficiency by widely introducing more aggressive use of nasal continuous airway pressure (nCPAP) and including Infant Flow technology would result in satisfactory outcomes. DESIGN: Prospectively defined analysis. SETTING: Fifty-seven secondary and tertiary care neonatal centers in Poland. PATIENTS: Patients were 1,299 newborns. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We carried out a prospectively defined analysis of 1,299 newborns included in the program between August 1, 2003, and April 30, 2005. The inclusion criterion was the occurrence of symptoms of respiratory failure irrespective of its etiology. Respiratory support was provided with the use of the Infant Flow Advance Driver. The analysis was made on data from prospectively designed questionnaires completed following each infant's treatment. Infants were placed into categories based on clinical indication for use. The primary end point was avoiding tracheal intubation. A high rate of acceptance of the new practice was observed across the substantial demographic and clinical diversity of newborns. Tracheal intubation was avoided in 78% of infants treated electively with nCPAP. Of those being weaned from mechanical ventilation, 61.2% were successfully weaned. Related complications were low (1.4% pneumothorax, 12% nasal injuries). CONCLUSIONS: The new method of nCPAP with Infant Flow was adopted as standard practice in Poland. We monitored its safety and effectiveness over a 2-yr period and found it to be safe and effective as implemented. Additional research is still needed to determine the optimum patient population, strategy for use, and devices.

Diagnostic utility of ultrasonography for respiratory distress syndrome in neonates.

BACKGROUND: Respiratory distress syndrome (RDS) is the most frequent cause of respiratory failure treated in the neonatal intensive care unit (NICU). The diagnosis is usually based on clinical manifestation and chest X-ray. The aim of the study was to investigate the possible role of chest ultrasound in the diagnosis of the RDS. MATERIAL/METHODS: Ultrasound examination was performed in 131 consecutive newborns admitted to the NICU in their first day of life with symptoms of respiratory failure. The method of ultrasound examination of the chest is based on the "mirror reflection" phenomenon arising on the pulmonary-diaphragmatic border. RESULTS: Retrohepatic or retrosplenic hyperechogenicity was shown in 109 of the 131 examined newborns and the diagnosis was confirmed by X-ray in 101 cases. RDS was diagnosed in no patient without retrohepatic or retrosplenic hyperechogenicity. In eight patients with positive ultrasound images unconfirmed by chest X-ray, congenital pneumonia (four cases) and pneumothorax (one case) were diagnosed and in three cases no pathology was found. CONCLUSIONS: The ultrasound examination is characterized by 100% sensitivity and 92% specificity in RDS. There was a strong positive correlation between ultrasound and X-ray imaging in the description of RDS severity (tau = 0.835; p < 0.001). Ultrasound examination cannot replace chest X-ray in the respiratory failure work-up as it overestimates the diagnosis, but it can be useful in excluding RDS as a cause of respiratory insufficiency in newborns.

Trisomy 18 in neonates: prenatal diagnosis, clinical features, therapeutic dilemmas and outcome.

The study aimed to analyse the clinical courses of aggressively treated neonates with cytogenetically confirmed trisomy 18, with special attention focused on the efficiency of prenatal diagnostics, associated malformations, therapeutic dilemmas and outcomes. We investigated retrospectively the data concerning 20 neonates with trisomy 18, admitted to the Neonatal Intensive Care Unit (NICU) in Katowice between January 2000 and February 2005. Their birth weights ranged from 650 g to 2400 g, mean 1812 g; gestational age ranged from 27 to 42 weeks, median 38 weeks. Intrauterine growth retardation was noticed in 90% of neonates. Trisomy 18 was suspected prenatally in 40% of cases. Most (80%) of newborns were delivered by caesarean section (92% of neonates with prenatally unrecognized chromosomal defects, 62% of neonates with trisomy 18 suspicion) and 70% of infants needed respiratory support immediately after birth. Cardiac defects were present in 95%, central nervous system malformations in 65%, severe anomalies of digestive system or abdominal wall in 25% of patients. Nine surgical operations were performed during hospitalization (4 were palliative cardiac surgeries). Six patients (30%) survived the neonatal period and were discharged from the NICU. The median survival of the neonates who died was 20 days. In 4 cases cardiac problems implicated their death; in others, deaths were attributed to multiorgan failure, prematurity and/or infection. Further improvement of efficiency of prenatal ultrasound screening for diagnosis of trisomy 18 in the fetus is necessary. A lack of prenatal diagnosis of trisomy 18 in the fetus results in a high rate of unnecessary caesarean sections in these pregnancies. Despite the aggressive treatment most neonates with trisomy 18 died during the neonatal period. The majority of deaths were attributed to cardiorespiratory and multiorgan failure. Concerning the poor prognosis, prompt karyotyping (using FISH) of clinically suspected trisomy 18 is very important, because many invasive procedures and surgeries may then be avoided.